Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…Patients with moderate-to-severe AR and severe AR undergoing noncardiac surgery had a higher in-hospital mortality 88 Predictors of in-hospital death included depressed LVEF (ejection fraction [EF] <55%), renal dysfunction (creatinine >2 mg/dL), high surgical risk, and lack of preoperative cardiac medications. In the absence of trials addressing perioperative management, patients with moderate-to-severe AR and severe AR could be monitored with invasive hemodynamics and echocardiography and could be admitted postoperatively to an intensive care unit setting when undergoing surgical procedures with elevated risk.…”

“…86 Left-sided regurgitant lesions convey increased cardiac risk during noncardiac surgery but are better tolerated than stenotic valvular disease. 88,89 AR and MR are associated with LV volume overload. To optimize forward cardiac output during anesthesia and surgery, 1) preload should be maintained because the LV has increased size and compliance, and 2) excessive systemic afterload should be avoided so as to augment cardiac output and reduce the regurgitation volume.…”

Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery.

“…Fifty-one patients underwent abdominal aortic aneurysm resection, 46 Stepwise logistic regression models were fitted to identify independent predictors of a cardiac event (all variables, regardless of significance from the univariate analysis, were entered into the multivariate analysis). The difference in risk was expressed as the odds ratio with the corresponding 95% confidence intervals (CI).…”

Pedal Bypass for Critical Limb Ischemia

“…Many algorithms have been proposed combining clinical risk indices, [13][14][15][16][17][18] exercise treadmill testing (ETT), [19][20][21] ambulatory electrocardiography (Holter monitoring), [22][23][24][25] radionuclide ventriculography (RNVG), 26,27 dipyridamole thallium scintigraphy (DTS), [28][29][30][31][32] dobutamine stress echocardiography, 33,34 and coronary angiography. 35,36 This vast array of tests and the multiple proposals for employing them indicates the absence of a consensus on the optimal approach for risk stratification in patients with peripheral arterial disease.…”